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72rosr2oia 22:�s <br />ELECTRICAL ERMIT APPLICATI4N <br />CITY O� EVER TT P��tIlA1T SE�iVIC�S <br />320D CEDAR S REET, EVERETT, WA 98201 <br />425-257-8810 - F 425-2�7-8857 �- www.everettwa.org <br />� <br />PRO,]ECT ADpRESS <br />��' �c�t-,�.�� <br />pwn�r <br />Tenant <br />��-�!'�!� �i1�� �P` <br />Electrical Contractor <br />� ���� �z � <br />State I-icense Number (required) <br />Q�/�--� <br />I'roposetl Use of Building <br />Sguare Footage (If residential new <br />Numbar of cievices (If low vc�ftage) <br />Descnption of Work ta Be Done: . <br />M,Oit AddreSS <br />Mail Addreas <br />Mail Address <br />� <br />remodel �r addition) <br />CITY OF EV6RER LOCILL 3Al_ES TAX COnE tS 3105 <br />� nereDy certl(y that / have reaa and examined this �pplicf <br />corr�cf_ AJ! provisions of laws and anlinancas govemin� i <br />whekher spe�ifred hereln or not The graniing of a pe�mit <br />violafe or cancel th� prnvisions of any other state or laca! <br />perfonnance af canstn�ction. That ! am auihaized by tHe <br />work for which applicatioi� is made and l camply with the : <br />296.2Q0 WAC. / / <br />os.w�zo�a <br />' � S! -r� 9 <br />Ciry � <br />C�ty <br />Stat�p <br />�5sso P.00lroo� <br />Phorie <br />�� n Phone <br />L,. <br />.�J' � ��/. <br />C�r " Sfate!"LiP PFwna <br />�o�r�3.�� <br />City oi Evarett Business Licenaa Number (required) <br />U � �_� <br />Contr�ct Pnce of Woric <br />Contact person/Contact Number/Emaii <br />FEE <br />�� � <br />z and know the same fo be tru� and <br />type of work wi!! ba completed <br />�s not presume ta give authority to PERMif# <br />rngulating constructio� or the ,�, � <br />ner of this praparty fo perfo»n the E����,��- <br />e Contractors Law 18.27 RCW snd <br />